In Dramatic Fashion, House Leaders Pull ACA Repeal and Replace Bill

What a week it was last week. Even as our staff here at NACHC has been pulling together the finishing touches for the 2017 Policy and Issues Forum (sure to be our best yet, by the way) last week was a roller coaster in terms of the future of major health reform legislation that was working its way through the House.

On Monday, it was clear that the bill House Republicans had initially introduced on March 6th didn’t seem to have the votes necessary for passage. Side deals with individual members were being cut, most notably the so-called “Buffalo Buyout,” championed by Rep. Chris Collins of New York, which was a direct appeal to win support from several members of upstate New York. Additional changes included the addition of an optional block grant and work requirement for states in the Medicaid program.

On Tuesday, the horse-trading continued in private meetings between the administration and Congressional members, with President Trump warning Congressional Republicans about the electoral ramifications of a failure to pass the bill by the target date of Thursday the 23rd – a symbolically important day for the President and the Leadership, as it marked 7 years to the day since the signing of the ACA.

On Wednesday evening, the drama heightened as members of the conservative House Freedom Caucus made a late deal with the administration to add additional changes to the bill – most notably provisions to repeal the so-called “Essential Health Benefits” provisions from the ACA, which outlined those services all individual market plans must cover under the law. The House Rules Committee met for 13 hours to prepare the bill to move to the floor.

Yet by Thursday it had become clear that even those last-minute changes were not enough to sway the votes of all members of the Freedom Caucus, many of whom continued to proclaim their opposition to the bill, and demand even further changes to the ACA. At the same time, more moderate House Republicans, most notably Charlie Dent of Pennsylvania, chair of the so-called “Tuesday Group” of moderates, were announcing their own opposition in light of the last minute changes. It became clear by mid-afternoon that the anniversary date would not be met, and the leadership decided to hold the bill until Friday.

Thursday night, President Trump issued an ultimatum to House members, saying that negotiations had ended, the bill would go to a vote, and if it failed, the administration was prepared to leave the ACA in place and move on.

Despite some last minute signals of new support, by mid-afternoon Friday the outcome was becoming clear -and at 4pm, Speaker Paul Ryan stepped to a podium and announced that the bill was being withdrawn, not having found the votes to pass it successfully.

As advocates are aware, NACHC had expressed some major concerns with the legislation, both in the form of a public statement and action alert, and in direct conversations with members and staff on the Hill. Yet while the provisions – mostly dealing with Medicaid changes – that gave us greatest concern will likely not be moving forward legislatively in the near future, it’s critical that all health center advocates know that we’ve only just begun the nationwide fight to make sure our centers and our patients can survive and thrive in this new environment.

That will be a theme that those 2,500+ advocates who are travelling to DC this week for the Policy and Issues Forum will hear over and over. Our policy and advocacy work must extend beyond Capitol Hill, into the new administration, state legislatures, governor’s offices and beyond. The opportunities health centers face – and the threats – are making themselves clear at EVERY level of government, and true advocacy success will mean being engaged at each of these levels.